WA News News & Reports Busselton Leads the Way
Busselton Leads the Way
Written by Jan Hallam
Friday, 30 September 2016

The Busselton Population Health Studies celebrates 50 years next month and there would be few doctors who have not been touched by its work in some way – be it personal involvement or having used some of its research findings at medical school or in their practice.
It’s like a faithful friend who’s always there but, at times, can be taken for granted. So in the golden glow of such a significant anniversary, it is fitting to remind ourselves what it has achieved and what it means to WA to have such a substantial and distinguished longitudinal population health study in our midst.
201010-Kevin-Cullen 0The Late Dr Kevin CullenIt’s certainly come a long way since Busselton GP Kevin Cullen pushed the idea in 1966 for a cross-disciplinary study of community health that would not only help to improve care but also provide research opportunities for undergraduates and post-graduates in the social sciences and medicine.
His ideas were music to the ears of young Perth-based researchers, endocrinologist Prof Tim Welborn, epidemiologist Dr Michael McCall, biochemist Dr David Curnow and CSIRO biostatistician Dr Norman Stenhouse.201610-Welborn-Tim-Dr-Jul15Prof Tim Welborn
And with a lot of hard work and forthright exchanges of opinion, the first health survey of 3394 Busselton adults took place in November 1966 with 1614 Busselton children surveyed the following year.
The surveys have changed shape as the population of Busselton has grown and become more mobile – from 6000 in 1966 to 36,000 in 2016 – and research focuses have changed reflecting worldwide clinical demand. Data and biosamples from the 20,368 Busseltonians who have participated have contributed to more than 400 local and international scientific papers across a broad range of chronic diseases.
Among the discoveries are:
•    The discovery of the first genetic association with asthma
•    Defining the clinical relevance of genetic testing in haemochomatosis
•    New gene discovery and confirmation of known genetic associations with CVD, respiratory disease, lung function, obesity, sleep apnoea, diabetes, iron metabolism and thyroid disease
And the list goes on but at the heart of it all is Kevin Cullen’s prime motivation – to demonstrate the health effects of the survey, or as Prof Welborn said in an oral history about the project: “No survey without Service”. The health care of the Busselton participants would be enhanced by their involvement.
After a period in the 1980s and 1990s when there were some widening survey gaps, the past decade has seen renewed and reinvigorated work on the longitudinal study owing in part to a permanent presence in the town.

The Busselton Population Medical Research Institute (BPMRI) has been established with director Dr Michael Hunter leading a core staff and overseeing the annual collection of data. Between 2005 and 2008, surveys have been conducted into the respiratory health of 4268 adults and children, sleep studies for 793 and obstructive lung disease. In 2008-09 the focus was diabetes and from 2010 the surveys have looked into healthy ageing and currently until 2020, the health of Baby Boomers.  
The eyes of the world are on Busselton.
201610-Michael-Hunter-Centre-Sign-1Busselton Study research director Dr Michael Hunter“A lot of our research goes to international conferences and the conversation and topic is Busselton. Particularly over the past 10 years, the data set has allowed us to get into large international collaborations exploring genetic causes for a range of diseases,” Michael said.
“Busselton is the first stop for many researchers because the data is here. The Busselton studies have really put WA medical research on the map. Local researchers such as Prof Fiona Stanley, who was involved in the study as a student collecting samples, to Nobel Laureate Prof Barry Marshall, who used data collected in Busselton for the transmission rates of helicobactor pylori, have mined what Prof Stanley describes as a treasure trove.
“It is a unique resource and as technology and scientific knowledge expands, the importance of the results collected over the past 50 years has become invaluable,” Michael said.
“The explosion of genetic technology over the past 10 years has seen researchers all over the world use DNA samples that were collected 30 years ago in the 1994-95 survey as they have moved from genome association studies to genomic location of a disease to genome sequencing.”
“The only way you can do these surveys is to have a really well phenotyped population like Busselton with DNA samples available. This is an irreplaceable resource.”
Research funding is tricky at the best of times, in fiscally constrained times even harder and Michael said the challenge is to keep the study and the work of the institute at the fore of public consciousness. But like many other research institutes, the competition for NHMRC grants is intense.
The BPMRI’s activities are supported by the State Government, UWA is the custodian of the database and PathWest the biosamples but to fund ongoing surveys a relatively modest $750,000 a year secured funding would ensure its future.
“With the permanent presence of the study in Busselton, the past 10 years have seen the community re-engage and we are starting to achieve good participation rates that match the earlier surveys. We are building momentum. Staff are trained and the people of Busselton are enthused. To lose that headway, or shut down survey activity would take a lot of time, resources and money to build back up again.”
ED: As part of the 50th anniversary an online publication and a hard copy history of the work of the Busselton Population Health Study is at http://bpmri.org.au.

While communication is one thing, investigation of notifications is another. We believe good doctors want the bad ones weeded out but they don’t want to be part of a witch hunt or get buried in lawyers, politics or paperwork.

The national Medical Board can respond to a complaint or act on the advice of the WA Medical Board to establish an assessment panel to either examine the health or performance and professional standards of a doctor. Health consumers are represented on panels along with medical practitioners.

The Medical Board and AHPRA have undisclosed lists of doctors who are approved by them as panellists and probably as expert witnesses. Many of these people, we believe, were ‘grandfathered’ across when National Law first came in (2010). Their impartiality is as unknown as they are. Then we have expected biases of the legal assessors, chosen by AHPRA, possibly thrown into the mix.

Is there a problem, Houston?

It is important this is sorted to everyone’s satisfaction as 42% of doctors in our survey thought panellists could lack impartiality to a serious extent.

In fact, only one quarter of doctors we surveyed (n=195) were happy with the impartiality shown by AHPRA or the Medical Board in processing a complaint (with 36% unhappy and 39% undecided). Nearly all of those who were unhappy said they were concerned that unfairness will be seriously damaging to someone. Investigation is a very confronting experience.

If someone is being investigated by a panel, either the panel or the person being investigated can opt for a more out-in-the-open State Administrative Tribunal (SAT) judicial hearing – the panel usually refers because it feels the evidence before it constitutes more serious professional misconduct.

What Fair Doctors Want

Talking to doctors, they appear to want an apolitical system of investigation that is fair and timely. They want to be treated reasonably. Unlike the legal profession, their work is mostly built around trust and honesty. They do not want a return to the ‘good old days’ where those with a political bent in the medical profession could influence what the Medical Board did.

While this is a very difficult area for us to investigate, with arguments and counter-arguments at every step, we cannot understand why the Medical Board would turn to arguably the most political organisation, the AMA, for its counsel (the national Board Chair met earlier this year with “senior leaders from AHPRA and representatives of the AMA” to workshop doctor complaints).

Why? Our e-Poll responses raise a question mark over the AMA’s involvement (and we don’t think AMA members have been polled on this issue.)

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